Healthcare Provider Details

I. General information

NPI: 1336737121
Provider Name (Legal Business Name): FELICE ELIZABETH CHANG MSN RN AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 ARROYO RD BLDG 90
LIVERMORE CA
94550-9650
US

IV. Provider business mailing address

1285 JULI LYNN DR
SAN JOSE CA
95120-5312
US

V. Phone/Fax

Practice location:
  • Phone: 925-373-4700
  • Fax:
Mailing address:
  • Phone: 408-425-5952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number812711
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number812711
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number812711
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License Number4883
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number4883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: